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Q:  David:  What has been your experience with a medication (Prozac) being prescribed to a patient who is bipolar/schizo-affective who is also taking Zyprexa and Tegretol.  I have read that Prozac (or other tricyclic antidepressants like it) can cause psychotic events to occur.  Thank you......

Dear G,

I am a psychologist, not a physician and therefore am not involved in the prescribing of medication.  I have been on Prozac in the past for depression without any side effects and have a 22 year old son who has been prescribed same for the past two years for ADD with no problems as well.

 Prozac or drugs which work on the same principle as Prozac -- Zoloft, Luvox, Paxil, Celexa etc. , are known as selective serotonin reuptake inhibitors (SSRIs) and are designed to block the metabolism of serotonin, thereby increasing levels of this neurotransmitter in the brain.

In the June 1999 edition of Clinical Psychiatry News for example, Dr. Malcolm Bowers, a psychiatrist at Yale had found that physicians are not paying enough attention to patient factors that could make treatment with SSRIs dangerous. He found that, "SSRI induced psychosis has accounted for eight percent of all hospital psychiatric admissions over a 14-month period...What is surprising is that this particular group of side effects is really underplayed."

Tricyclic antidepressants are a class of antidepressant drugs first used in the 1950s.  For many years they were the first choice for pharmacological treatment of depression. Although still considered effective, they have been increasingly replaced by SSRIs and other newer drugs. These newer antidepressants are thought to have fewer side effects and are also thought to be less effective if used in a suicide attempt, as the treatment and lethal doses are farther apart than with the tricyclic antidepressants.
Multi-Drug Interaction Checker     (Medscape from WebMD)
Patient Regimen

Moderate Interaction
Tegretol Oral and Fluoxetine Oral may interact based on the potential
interaction between CARBAMAZEPINE and SELECTED SSRI'S.

This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or DISCONTINUING any drug or commencing any course of treatment.

MONOGRAPH TITLE: Carbamazepine/Selected Selective Serotonin Reuptake

SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed.

Remember to discuss this with your physician first and foremost.  Psychosis can also be a symptom of both bipolar and schizoaffective disorders.  Communicate openly about all of the symptoms and behaviors and allow your psychiatrist to be as persistent as possible in getting as much information as he or she can from you. 

David Schafer, M.Ed.
Staff Psychologist

Published April, 2006


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